Permit CITY OF TIGARD MASTER PERMIT
'. COMMUNITY DEVELOPMENT Permit#: MST2019-00373
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 10/21/2019
TIGARD9
Parcel: 2S112BD11800
Jurisdiction: Tigard
Site address: 7674 SW HANSEN LN
Subdivision: ELDERBERRY RIDGE Lot: 14
Project: Elderberry Ridge, Lot 14
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 5 First: 1194 sf Basement: 835 sf Left: 5 Parking Spaces: 0
Height: 31 Bathrooms: 4 Second: 1108 sf Garage: 383 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 3137 sf Value: $407,792.09 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer 100
Drains: 0
Tubs/Showers: 5 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 1
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 6 Clothes Dryers: 1
Natural Gas Heat Pump: Y Hoods: 1 Other Units:
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 6 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 3137
Owner: Contractor:
RIVERSIDE HOMES LLC RIVERSIDE HOMES LLC Required Items and Reports(Conditions)
17933 NW EVERGREEN PL STE 17933 NW EVERGREEN PKWY 370 1 Ersn Cntrl 503-639-4175
370 BEAVERTON,OR 97006
BEAVERTON,OR 97006
PHONE: 503-645-0986 PHONE: 503-645-0986
FAX: 503-690-2942
Total Fees: $35,673.94
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes :nd - other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance or i work is suspended for more the 180
days. ATTENTION: Oregon law requires y. to folio the rules adopted by the Oregon Utility Notification Ce ter. �Those rules are set forth in OAR
952-001-0010 through -00),(490. You,ay obtai/-cop . he rules or dir-ct questions to OUNC by calling 503.232.14:: or91.800.332.2344.
Issued By: . •1- i r Permittee Signature: y
' Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application �"^--
Residential FOR OFFICE USE ONLY
City of Tigard Date/Byy 1 ( `% 9 i�7de,/ —063)3
Ili - 13125 SW Hall Blvd.,Tigard,OR 97223 [p Plan Review ('ZJeI
r/� ��Phone: 503.718.2439 Fax: 503.598.196 i' Q DateBy: tq 1 , P t
T I c,A R D Inspection Line: 503.639.4175 Date Ready/By: Joliet �: ® See Page 2 for
Internet: Line: ard-or.gov CITYd 1^ "' ) to ed/Metho [ Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑✓ New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑r 1-and 2-family dwelling 1:1Commercial/industrial
Valuation: $ 9 191—
u-7'
0 Accessory building 0 Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms: 4
JOB SITE INFORMATION AND LOCATION Total number of floors: 3 52.1
Job site address: 7674 SW Hansen Ln New dwelling area: 3137 square feet U Ora
City/State/ZIP: Tigard, OR 97224 Garage/carport area: 383 square feet L(cit4
?,SCrSuite/bldg./apt.no.: Project name: Elderberry Ridge Covered porch area: square feet (82,s—
Cross
oss street/directions to job site: SW Bonita Rd &SW 76th Ave Deck area: .•;
,
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received
13125 SW Hall Blvd.,Tigard,OR 97223
DateBy: Permit No.:
IIPhone: 503.718.2439 Fax: 503.598.1960 Associated permits:
T t C;A K 1) 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ 0
3 Verification of approved plat/lot. 0 ❑ 0
4 Fire district approval required. Name of district: . 0 0 ❑
5 Septic system permit or authorization for remodel. Existing system capacity _ _ 0 0 ❑
6 Sewer permit. ❑ 0 0
7 Water district approval. ❑ 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 0
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if 0 0 0
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 0 0
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- 0 0 0
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 0 0 0
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- 0 0 0
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing 0 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 0
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists 0 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ 0 0
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ❑ 0 0
architect licensed in Ore:on and shall be shown to be a..licable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 0 0
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 0
27 "Drawn to scale"indicates standard architect or engineer scale. 0 0 0 j
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 0
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 0 0
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9,1995.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-461 3T(1 1/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Dw.-.€ '" '''. ° - Received
Date/By: Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 c r Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 �= BDate Ready/By: Juris- ® see Page 2 for
Internet: www.tigard-or.gov PP
Notified/Method: Supplemental Information
i
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
✓❑New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION
""' RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
El 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75 46.75
Job site address: 7674 SW Hansen Ln Furnace 100,000 BTU(ducts/vents) 1 46.75 46.75
City/State/ZIP: Tigard, OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 1 61.06 61.06
Suite/bldg./apt.no.: Project name: Elderberry Ridge Duct work 23.32
Cross street/directions to job site: SW Bonita Rd &SW 76th Ave Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Other: 23.32
Subdivision:
Elderberry Ridge Lot no.: 14 Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 33.39 33.39
Flue vent for water heater or gas
Construction of SFR fireplace 1 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
ElPROPERTY OWNER ❑ TENANT Other: 23.32
`' Environmental exhaust and ventilation:
Name: Riverside Homes, LLC Range hood/other kitchen
equipment 1 33.39 33.39
Address: 17933 NW Evergreen PI., Ste 370 Clothes dryer exhaust 1 33.39 33.39
City/State/ZIP: Beaverton, OR 97007 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 5 23.32 116.60
Phone:(503 )645-0986 Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ElCONTACT PERSON Other: 23.32
Business name: Riverside Homes, LLC
Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Nikki Pruett Furnace,etc. 1 14.15
Address: 17933 NW Evergreen Pl., Ste 370 Gas heat pump >( 14.15
Wall/suspended/unit heater '( -20:517'
City/State/ZIP: Beaverton, OR 97007 Water heater 1 14.15
Phone:(503 )645-0986 Fax::( ) Fireplace 1 14.15
Range 1 14.15
E-mail: npruett@riversidehome.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: Pro Heating & Cooling Other:
MECHANICAL PERMIT FEES*
Address: 2095 NW Alocleck Rd.#1103 Subtotal
City/State/ZIP: Hillsboro, OR 97124 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( 971)205-4989 Fax:( ) State surcharge(12%of permit fee)
CCB lic.: 209001 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature ( / ✓ * Fee methodology set by Tri-County Building Industry Service Board
Print name: Nikki Pruett Date: 9/18/19
I:\BuildingTemlits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC PermitApp_040113.doc 2
t
Electrical Permit Application '" '"' •-' FOR OFFICE USE ONLY
City of Tigard "¢Received
Date/B : Permit#:
' Z.
II mil 13125 SW Hall Blvd.,Tigard,OR 97223 SEP 1 9 " 19 Plan Review
II Phone: 503.718.2439 Fax: 503.598.1960 '' Date/B : Related Permit#:
T I G A R D Inspection Line: 503.639.4175 r'._., Ready Date/By: Juris: E See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
ElNew construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition ❑Other: 0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑✓ 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder
❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
o Addition of new motor load of system.
7674 SW Hansen Ln
Job#: Job site address: 100HP or more. ❑"A","E","l-2","l-3",
City/State/ZIP: Tigard, OR 97224 0 Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Elderberry Ridge 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: SW Bonita Rd &SW 76th Ave FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Elderberry Ridge Lot#: 14 Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
sq. 75.00 2
Construction of SFR (with above )
ft.
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Q PROPERTY OWNER l=1 TENANT Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Name: Riverside Homes, LLC 200 amps or less 100.70 2
Address: 17933 NW Evergreen PI., Ste 370 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Beaverton, OR 97007 601 amps to 1,000 amps 301.04 2
Phone:(503)645-0986 Fax:( ) Over 1,000 amps or volts 552.26 2
Email:
Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
.,—` Branch circuits—new,alteration,or extension,
0 APPLICANT ❑✓ CONTACT PERSON A.Fee for branch circuits with per panel
Business name: Riverside Homes, LLC above service or feeder fee,
7.42 2
each branch circuit
Contact name: Nikki Pruett B.Fee for branch circuits without
Address: 17933 NW Evergreen Pl., Ste 370 anchcirfeeder fee,first
branch crcuit 56.18 2
br
City/State/ZIP: Beaverton, OR 97007 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)645-0986 Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: npruett@riversidehome.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sunlight Electric Inc Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy e
Address: 2804 NE 65th Ave. St. D panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Vancouver, WA 98661 Additional inspection(1 hr min) 66.25/hr
Phone:(360) 518-7589 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: CO f
`/1-2— Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lie.: 172549 Electrical Lie.: 0230 Suprv.Lic.:/7.9 3 S specifically listed(/2 hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Chester Garrett Date: 9/18/19 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature:L;k6/i 6, A TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Nikki Pruett Date: g/18/1 9 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(I 1/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qhs. Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n Burglar Alarm 25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
✓❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems*
>100 kva no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
n Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(A hr min)
COELECTRICAL PERMIT FEES
MLIERCIAL WORK ONLY;:,
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
Plumbing Permit Application
Building Fixtures r' 77 i 7 FOR OFFICE USE ONLY
li
City of Tigard Received
Date/By: Permit No.:
111111 C • 13125 SW Hall Blvd.,Tigard,OR 97223 C p 1 q 7 819 Plan Review
Phone: 503.718.2439 Fax: 503.598.196" ` DateBy: Other Permit No.:
TI G A R D Inspection Line: 503.639.4175 Date Read/B Avis: See Page 2 for
Internet: www.tigard-or.gov Ready
/By:
Notified/Methoo
d: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
Ll New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
ll 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 1 500.32
0 Master builder - Each additional bath/kitchen 1 25.02 25.02
❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 7674 SW Hansen Ln Catch basin or area drain 18.76
ty Tigard, O R 97224 Drywell,leach line,or trench drain 18.76
City/State/ZIP:
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Elderberry Ridge Manufactured home utilities 50.03
Cross street/directions to job site: SW Bonita Rd &SW 76th Ave Manholes 18.76
Rain drain connector 1 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Elderberry Ridge I Lot no.: 14 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Construction of SFR Clothes washer 1 25.02
Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
ElPROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Riverside Homes, LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 17933 NW Evergreen Pl., Ste 370
Garbage disposal 1 25.02
City/State/ZIP: Beaverton, OR 97007 Hose bib 2 25.02
Phone:(503)645-0986 Fax:( ) Ice maker 1 12.51
,
0 APPLICANT Q CONTACT PERSON Interceptor/grease trap 25.02
Business name: Riverside Homes, LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Nikki Pruett
Roof drain(commercial) 12.51
Address: 17933 NW Evergreen Pl., Ste 370 Sink/basin/lavatory 7 25.02
City/State/ZIP: Beaverton, OR 97007 Solar units(potable water) 62.54
Phone:(503)645-0986 Fax::( ) Tub/shower/shower pan 5 12.51
E-mail: npruett@riversidehome.com Urinal 25.02
Water closet 4 25.02
CONTRACTOR
Water heater 1 37.52
Business name: H & H Mecanical Waterpiping/DWV 56.29
Address: 5757 SE Willow Ln Other: 25.02
City/State/ZIP: Milwaukie, OR 97267 Subtotal
Phone:( 503 975-9787 Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 178122 Plumbing Lic.no.: PB414 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature:
l/'44,
! TOTAL PERMIT FEE
Print name: Nikki Pruett Date: 9/18/19 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: PermitFee:
Footing drain-151 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees Qty• Fee
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge 2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
Isometric or Riser Diagraoai
Car Wash Drain
Garbage -Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\npruett\Downloads\PLMF_PermitApp.doc 2
t
Plumbing Permit Application "? "
BuildingFixtures
FOR OFFICE USE ONLY
SEP 1 9 .f
City of Tigard Received
II
No.:
III • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 ,w. Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 Date Read/B Juris: 0 See Page 2 for
Internet: www.tigard-or.gov Ready/By:
Notified Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
M New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
0 1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
El Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 7674 SW Hansen Ln Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR 97224
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Elderberry Ridge Manufactured home utilities 50.03
Cross street/directions to job site: SW Bonita Rd & SW 76th Ave Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Elderberry Ridge 1 Lot no.: 14 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Construction of SFR Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Riverside Homes, LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 17933 NW Evergreen Pl., Ste 370
Garbage disposal 25.02
City/State/ZIP: Beaverton, OR 97007 Hose bib 25.02
Phone:(503)645-0986 Fax:( ) Ice maker 12.51
Q APPLICANT Q CONTACT PERSON Interceptor/grease trap 25.02
Business name: Riverside Homes, LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Nikki Pruett
Roof drain(commercial) 12.51
Address: 17933 NW Evergreen Pl., Ste 370 Sink/basin/lavatory 25.02
City/State/ZIP: Beaverton, OR 97007 Solar units(potable water) 62.54
Phone:(503)645-0986 Fax::( ) Tub/shower/shower pan 12.51
E-mail: npruett@riversidehome.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: TruScapes Waterm in WV
pip g� 56.29
Address: 21600 NW Amberwood Dr. Other: 25.02
City/State/ZIP: Hillsboro, OR 97124 Subtotal
Phone:( 503 531-8216 Fax:( ) Minimum permit fee: $72.50
CCB Lie.: Plan review (25%of permit fee)
LCB#7962 3! 0 Plumbing Lic.no.:
/ State surcharge(12%of permit fee)
Authorized signature: ;(e&. . " TOTAL PERMIT FEE
Print name: Nikki Pruett Date: 9/18/19 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PernutApp.doc 10/01/09 440-4616T(10/02/COM/wEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty Fee(ea) Total Square Footage: Permit Fee:
Footing drain-l'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' Valuation: Permit Fee:
62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) '". Total' each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge 2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type Plan Reviewfor Plumbing-Installations
Fixture Type for Replace/ Ilti)inl,*l nStallatlQliS
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower El Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
4"
Isometric or Riser Diagram
Car Wash Drain
Garbage -Domestic-non-food 0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\npruett\Downloads\PLMF_PermitApp.doc 2
City of Tigard
~ COMMUNITY DEVELOPMENT DEPARTMENT
IN ■
T 1 c A D Building Permit Review — Residential
Building Permit #: ///(47-2.0/ ..C797;
Site Address: 7 \J 9b
Project Name: e,'it,- Re Lot #:
(New dwellin =subdivi, on name;Addition or Alteration=last name of owner)
Planning Review
Pr posal: VP&J SK Om, *3 .?'
me Verify address/suite#active in Accela. In River Terrace: 11Ll No ❑ Yes,River Terrace Review
Addendum
Sit: Plan Elements: Psion Control
/f, -spies of site plan on 8-1/2"x 11"or 11 x 17"paper et ' ed trees with drip line and tree protection measures
co.yawn to scale(standard architect or engineer scale) ootprint of new structure(including decks)and FFE
4th arrow [ [Utility locations&easements (required for new and additions)
address,project or subdivision name and lot number idewalk/driveway approach
.plicant information(name and phone number) /r• . ation of wells/septic systems
E •t dimensions and building setback dimensions li S et tree size,type and location
.14
are footage of buildings to be demolished treet names
_.Eisting structures on siteCorner elevations(2'contours if more than 4'differential)
Dtot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes ❑No
envious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes ❑No
Ltd Clean Water Services—Service Provider Lette of plattedprior
to 9/10/1995):
utred: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
Public Facilitimprovement(PFI) Permit:
Required: 5 Yes,applicant was notifiedCI No Appli For: LV Yes CINo,stop intake
r pI
nd Use Case#: f X1.916-0000 p 1 oning. kJ- (1_2Y)
t quired Setbacks: Front: 13 Rear: l S Side: S Street Side: Garage: Z
R BB'uilding Height: Max. Height: Actual Height: 3 i
LLYLandscape t�,rea: � % Lot Coverage Max kU
1jJ J ntranceyam"/ t back no more than 8'from street-facing wall lid Parallel to street or offset 45 degrees or less
Windows um 12%of area of all street-facing facades 20l
1 Garage Garage door is behind widest street-facing wall ❑ Yes No,one of the following is met:
r ❑ or extends no more than 5'from wall and there is a covered porch extending beyond garage.
Door extends no more than 5'from�wand there is a 12 sq ft.window above garage on 2nd floor.
�vn Garage door width is ❑ 12'or less [ '50%or less of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ❑ Recessed entrance 0 Wall offset ❑ 1'Roof eave ❑ Roof offset
10'1 ❑ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer
❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ Balcony
( /Vlual Clearance ��ban Forestry Plan }
L i - sitive Lands: [ Yes CI No Type: S LH -7 2C/`
9(
V Conditions prilflr o issuance ofbuilding,Permit
Ute (� "'1.4-1 T� Mi;r �n)di �' Ji„,..K
[l�'Approved By Planning: C,r Date: cr'i!q-[
1
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
I:\Building\Fonns\BldgPennitRvw RES 022819.docx
Building Permit Submittal
Original Submittal Date: 777 l l
Site Plans: #
Building Plans: #
Building Permit#: fi -" ter buildin permit#above.
Workflow Routing: '► Planning gineering rmit Coordinator wilding
Workflow Sign-off: I." Sign-off for Planning(include notef� rom planning review)
Route Application Documents: P. Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
Building. original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: / - /
/�1 �� iir
By Permit Technician: // Date:
Engineering Review
lope at building pad: ;.,
16 Conditions "Met"prior to issuance of building permit
asements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ENo
Assess Water Quantity Fee in-lieu: ❑ Yes E"No
LIDA Facility on lot: 0 Yes 'No
❑ Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes: .."
,VRevApproved by Engineering: / Date: 0-1/7- --
Revisions
isions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
i❑�815C Fees Entered: Wash Co Trans Dev Tax: 'Yes ❑ N/A
VV Tigard Trans SDC: 1 -s ❑ N/A
Parks SDC: I Yes ❑ tJA
LIDA ❑ YesN/A
K to Issue Permit
Approvedby Permit Coordinator: firr7Date:#2".3hicr
I:\Building\Forms\BldgPern itRvw_RES_022819.docx
FOR OFFICE USE ONLY–SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Ns Transmittal Letter
etter
T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUIL ING DIVISION t ;y,�.
NOV1 , 2019
FROM: [2_,1,....)-(24–C-,( .� Gay 4. .7 "
11 r"(,lir , , e ARD
COMPANY: !' �� ` � rl �� Ir Y
PHONE: q /` Zc-)Z 3 ii 5-2— By:
RE: 7 (:,7-VV.,-,. .„ Lo ,i,f 7- .✓f J %4!.
(Site Address) (Permit umber)
i' .4-Nr el ° I i
Li
(Project name or subdivision name and lot number)
r
ATTACHED ARE THE FOLLOWING ITEMS '/'
Copies: Description: Copies: Description:
I
Additional set(s) of .i .,4 s. X Revisions: F-. \-- -._ j -k\fU",q
Cross section(s) and . {,is. Wall bracing and/or lateral analysis.
Floor/roof framing. r Basement and retaining walls.
Beam calculations. \ Engineer's calculations.
Other(explain):
REMARKS:
FO OFF CE USE ONLY
Routed to Permit T c,..ici. /Date: 1( (� l.1 Initials: �' '"
Fees Due: ❑ Y a , a/ Fee Des 'pti : Amount Due:
lb / i -c-.. $ (c,>5---____
$
Special
Instructions:
Reprint Permit(per PE): ❑ Yes gni o ❑ Done
Applicant Notified: Date: /17/ , /`t Initials: /J/
I:\Building\Forms\TransmittalLetter-Revisions_061316.doc